Stress biomarkers and child development in young children in Bangladesh.

BACKGROUND: Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh. METHODS: We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables. RESULTS: We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We detected a significant relationship between HPA axis activity and child development, where increased HPA axis activity was associated with poor development outcomes. Specifically, we found that cortisol reactivity (coefficient -0.15, 95% CI (-0.29, -0.01)) and post-stressor levels (coefficient -0.12, 95% CI (-0.24, -0.01)) were associated with CDI comprehension score, post-stressor cortisol was associated with combined EASQ score (coefficient -0.22, 95% CI (-0.41, -0.04), and overall glucocorticoid receptor methylation was associated with CDI expression score (coefficient -0.09, 95% CI (-0.17, -0.01)). We did not detect a significant relationship between SAM activity or oxidative status and child development. CONCLUSIONS: Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.

Effectiveness of combined interventions to empower girls and address social norms in reducing child marriage in a rural sub-district of Bangladesh: A Cluster Randomised Controlled Trial of the Tipping Point Initiative.

Background: Elimination of girl child marriage (CM) globally at the current pace is projected to take about 300 years. Thus, innovative and effective solutions are urgently warranted. Bangladesh reports one of the highest rates of CM in the world. We present the impact of Tipping Point Initiative (TPI), a combined intervention to empower girls and to address social norms on CM in Bangladesh. Methods: A three-arm non-blinded Cluster Randomised Controlled Trial was conducted in 51 villages/clusters in a sub-district of Bangladesh. Clusters were randomly assigned to the arms: Tipping Point Program (TPP), Tipping Point Program Plus (TPP+), and Pure Control. TPP conducted 40 weekly single-gender group sessions with never-married adolescent girls and boys recruited at 12 -<16 years; and 18-monthly gender-segregated group sessions with the parents. On top of TPP, TPP+ included cross-gender and -generation dialogues, girls' movement building and girl-led community sensitisation. Intention-to-treat analysis was performed to assess the impact of TPI on the hazard of CM, the primary outcome. The impact of girls' session attendance on CM was also assessed. At baseline 1275 girls (TPP = 412; TPP+ = 420; Control = 443) were interviewed between February-April 2019. At endline 1123 girls (TPP = 363; TPP + = 366; Control = 394) were interviewed and included in the analyses. Results: No intervention impact was detected on the full sample (TPP vs. Control: adjusted hazard ratio (aHR) = 1.14; 95% CI = 0.79-1.63, P = 0.47), (TPP + vs. Control: aHR = 1.24; 95% CI = 0.89-1.71, P = 0.19, (TPP vs. TPP+: aHR = 1.03; 95% CI = 0.72-1.47, P = 0.87). However, in the TPP arm, the hazard of CM was reduced by 54% (aHR = 0.46; 95% CI = 0.23-0.92, P = 0.03) among the girls in the highest tertile of session attendance, compared to the lowest. In the TPP+ arm, this hazard was reduced by 49% (aHR = 0.51; 95% CI = 0.23-0.92, P = 0.03) among girls in the highest tertile, compared to the lowest tertile. Conclusions: Although TPI did not show an effect on CM in any of the intervention arms, within each intervention arm, a positive effect was detected in reducing CM among girls in the highest tertile of session attendance despite implementation challenges due to COVID-19. Registration: Clinicaltrials.gov: NCT03965273; Date: 29 May 2019.

Development and validation of the Economic Coercion Scale-20 (ECS-20): A short-form of the ECS-36.

The Economic Coercion Scale 36 (ECS-36) is a validated scale measuring women's exposure to economic coercion for low-income countries. A valid short form is needed to facilitate parsimonious measurement of economic coercion in general surveys or program evaluations. We used data from a probability sample of 930 married women 15-49 years in Matlab, Bangladesh. We selected 21 items from the ECS-36 based on theory, content coverage, and item and dimensional information. We evaluated external validity with measures of non-economic intimate partner violence and depressive symptoms. We tested measurement invariance of the short-form scale across participants and non-participants of microfinance programs. A final, 20-item scale captured husband's interference with wife's (1) acquisition of economic resources and (2) use or maintenance of economic resources. IRT results of the ECS-20 demonstrated precision over the higher range of the economic coercion trait. Tests of external validity confirmed expected correlations of the ECS-20 with measures of IPV and depressive symptoms. The ECS-20 was measurement invariant across groups of women who did and did not participate in microfinance programs. The ECS-20, a valid short-form of the ECS-36, is suitable for general surveys and monitoring potential adverse impacts of microfinance programs targeting women.

Micronutrient status during pregnancy is associated with child immune status in rural Bangladesh.

Background: Poor immune function increases children's risk of infection and mortality. Several maternal factors during pregnancy may affect infant immune function during the postnatal period. Objectives: We aimed to evaluate whether maternal micronutrients, stress, estriol, and immune status during the first or second trimester of pregnancy were associated with child immune status in the first two years after birth. Methods: We conducted observational analyses within the water, sanitation, and hygiene (WASH) Benefits Bangladesh randomized controlled trial. We measured biomarkers in 575 pregnant women and postnatally in their children. Maternal biomarkers measured during the first and second trimester of pregnancy included nutrition status via vitamin D (25-hydroxy-D [25(OH)D]), ferritin, soluble transferrin receptor (sTfR), and retinol-binding protein (RBP); cortisol; estriol. Immune markers were assessed in pregnant women at enrollment and their children at ages 14 and 28 mo, including C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), and 13 cytokines (including IFN-γ). We generated a standardized sum score of log-transformed cytokines. We analyzed IFN-γ individually because it is a critical immunoregulatory cytokine. All outcomes were prespecified. We used generalized additive models and reported the mean difference and 95% confidence intervals at the 25th and 75th percentiles of exposure distribution. Results: At child age 14 mo, concentrations of maternal RBP were inversely associated with the cytokine sum score in children (-0.34 adjusted difference between the 25th and 75th percentile [95% confidence interval -0.61, -0.07]), and maternal vitamin A deficiency was positively associated with the cytokine sum score in children (1.02 [0.13, 1.91]). At child age of 28 mo, maternal RBP was positively associated with IFN-γ in children (0.07 [0.01, 0.14]), whereas maternal vitamin A deficiency was negatively associated with child AGP (-0.07 [-0.13, -0.02]). Maternal iron deficiency was associated with higher AGP concentrations in children at age 14 mo (0.13 [0.04, 0.23]), and maternal sTfR concentrations were positively associated with child CRP concentrations at age 28 mo (0.18 [0, 0.36]). Conclusion: Maternal deficiencies in vitamin A or iron during the first 2 trimesters of pregnancy may shape the trajectory of a child's immune status.

Factors Associated With Domestic Violence Against Women at Different Stages of Life: Findings From a 19-Year Longitudinal Dataset From the MINIMat Trial in Rural Bangladesh (2001-2020).

Despite the abundance of literature, longitudinal studies evaluating the factors associated with domestic violence (DV) at different stages and over longer periods of women's lives are rare. We evaluated factors associated with physical and sexual DV during pregnancy, at 10-year, and 18-year follow-ups after pregnancy and within a 19-year period of life using a cohort of women (n = 1,126) who participated in the Maternal and Infant Nutrition Interventions, Matlab trial in rural Bangladesh. Data on women's experience of DV, social and economic characteristics, empowerment, and family condition were recorded in a similar manner during pregnancy and at 10- and 18-year follow-ups, using standard questionnaires. Multivariate logistic regression models and generalized estimating equations were used to evaluate factors associated with women's experience of physical and sexual violence at each discrete time point and over a period of 19 years, respectively. During pregnancy, women were more likely to experience violence if they were members of microcredit programs/non-governmental organizations (NGOs), living in an extended family and had lower wealth status. At the 10- and 18-year follow-ups, higher levels of decision-making and higher wealth status were protective against the experience of violence. At the 18-year follow-up, women with larger age differences from their husbands were less likely to experience violence, while membership in microcredit programs/NGOs was associated with higher odds of experiencing violence among women. Within a period of 19 years, a higher level of education, living in an extended family, higher decision-making level and higher wealth index were protective against the experience of violence, while membership in microcredit programs/NGOs was a risk factor. In conclusion, this study showed that correlates of violence might change at different time points in women's life. Thus, policies and programs should consider the stage of women's lives while planning interventions for addressing violence against women.

Multi-level analysis of the determinants of physical domestic violence against children using longitudinal data from MINIMat mother-child cohort in Bangladesh.

Objectives: Despite high levels of physical violence against children (VAC) globally (40-50%), the literature on the determinants of VAC remains inconclusive. Most of the literature on this topic is based on cross-sectional data, and the multi-level nature of the drivers of VAC is widely ignored. This leads to model specification problems and an inability to draw causal inferences. Moreover, despite the higher prevalence of VAC in low-and middle-income countries, studies from high income countries dominate the field. We examined the determinants of physical domestic VAC to address these gaps in the literature. Methods: Data were collected between 2001 and 2020 from 762 mother-child dyads recruited in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study in Bangladesh. We conducted multi-level logistic regression analyses to identify the determinants of physical domestic VAC. Results: Prevalence of physical domestic violence against girls (69%) and boys (62%) was extremely high. Community-level prevalence of physical domestic VAC increased the likelihood of physical domestic VAC at the individual level across gender (girls - OR-5.66; 95% CI- 3.11-10.32; boys - OR-7.67; CI- 3.95-14.91). While physical domestic violence against mothers was not associated with physical domestic violence against girls, it reduced the likelihood of such violence against boys by 47%. Having 3 or more siblings predicted physical domestic violence against girls (OR-1.97; 95% CI- 1.01-3.81 for 3 siblings; OR-4.58; 95% CI- 2.12-9.90 for 4 or more siblings), but not against boys. While girls in Hindu families were more likely to experience this violence, the boys were not. Mother's education, employment non-governmental organization (NGO) participation and, household wealth did not predict this violence against any gender. Conclusion: We contend that physical domestic violence against mothers reflects an emphasized patriarchal culture in a family where a boy is less likely to experience physical domestic violence. Social norms and social learning theories explain the greater likelihood of a child experiencing physical domestic violence in a village with a higher level of such violence. We conclude that social norms around physical domestic VAC and patriarchal culture need to be changed to effectively address this violence.

Effect of Rural-Urban Migration on Age at Marriage Among Adolescent Girls in Bangladesh.

Objectives: Bangladesh reports one of the highest rates of child marriage (CM) (59%) in the world and the highest rate within South Asia. Age at marriage of girls is a critical human rights and developmental issue in Bangladesh. Migration has been documented to be positively associated with age at marriage. Bangladesh experiences one of the highest rates of rural to urban migration in the world. An increase in rural-urban migration of adolescent girls has been observed over the last few decades in Bangladesh with the expansion of employment opportunities particularly in the ready-made garment industry (RMG). This analysis explores the effect of migration on age at marriage and CM among adolescent girls living in urban slums of Dhaka. Methods: The sample was selected from icddr,b's Urban Health and Demographic Surveillance System (UHDSS) and comprises of never-married adolescent girls aged 15-19, who migrated in from rural Bangladesh to slums in and around Dhaka during 2015-2019. These in-migrants were matched with their rural counterparts from icddr,b's Matlab HDSS (MHDSS), using one to one nearest neighbor matching with caliper 0.1 using propensity score matching (PSM) method. The sample derived included a total of 2,700 never-married adolescent girls from Dhaka and Matlab. The association between migration and age at first marriage was estimated using a linear regression model and the effect of migration on CM was explored using logistic regression analyses. Results: The in-migrants perfectly matched with their rural peers in terms of age, household wealth and religion. However, their income earning status was hugely different. Urban migrants had significantly higher age at marriage than the rural non-migrants for both 15-19 (Coefficient, 1.77; 95% CI, 1.07-2.46) and 20-24 years age group (Coefficient, 2.87; 95% CI, 2.18-3.55). The migrant girls aged 20-24 years were 71% (aOR, 0.29; 95% CI, 0.12-0.69) less likely to get married before CM age bar in Bangladesh compared to their rural counterparts. Conclusion: Migration has a positive effect on delaying marriage and reducing CM among adolescent girls. Findings from this study suggest that CM can be reduced by creating educational and economic opportunities for females.

A cluster randomized controlled trial for measuring the impact of a social norm intervention addressing child marriage in Pirgacha in Rangpur district of Bangladesh: study protocol for evaluation of the Tipping Point Initiative.

Child Marriage (CM) is one of the major developmental concerns in Bangladesh, reporting one of the highest rates of CM (59%) globally. To date, interventions to address CM in Bangladesh have failed to seriously engage with social norms that are important contributors to CM. This paper describes the evaluation design of the Tipping Point Initiative that aims to reduce CM through social norm change and increasing adolescent girls' agency to voice their rights. The Tipping Point Initiative evaluation trial employs a mixed method design. The quantitative component includes a three-arm Cluster Randomized Controlled Trial design, where Arm 1 receives Tipping Point Program (TPP); Arm 2 receives Tipping Point Program Plus (TPP+), a social norms-enhanced version of TPP; and Arm 3 is the Control. The trial covers 51 clusters (villages) in Pirgacha, in Rangpur district, randomized into three study arms (17 per arms). From each cluster, a cohort of 25 adolescent girls aged 12-<16 years were selected randomly for participation in the survey and intervention. Further, a cross-section of adults (six males and six females) were randomly selected from each cluster for survey. Qualitative baseline data were collected from two purposively selected intervention villages in each intervention arm. Thirty In-Depth Interviews, eight Key Informant Interviews and 16 Focus Group Discussion were conducted with adolescent girls, boys, adult women and men. Same strategies have been followed at endline. The intervention was implemented from April 2019 to December 2020. The endline was conducted 10 months after the end of intervention. Intention-to-treat analysis approach will be used for impact assessment. Both narrative analysis and Grounded Theory approach will be employed in analysing qualitative data. The learnings are expected to inform programs and policies regarding what works and does not work to address CM in such social norms intervention in Bangladesh.

An Exploration of Social Norms That Restrict Girls' Sexuality and Facilitate Child Marriage in Bangladesh to Inform Policies and Programs.

PURPOSE: Despite international commitments and increases in education and economic opportunities for girls and young women, child marriage persists and, in some contexts, reductions have stagnated. In order to accelerate and sustain progress, a better understanding of the social norms that continue to support the practice is required. METHODS: This qualitative study used 20 in-depth interviews with adolescent girls and another 10 with boys, a total of 16 focus group discussions with girls, boys, and parents of adolescent girls, and 8 key informant interviews with community leaders, to identify and understand the expectations that support the practice of child marriage, in communities in northern Bangladesh. RESULTS: Expectations that girls will restrict their mobility, limit their engagement with male peers, and take extremely limited decision-making roles in their marriage reinforce the practice of child marriage. Girls, and their families, that are considered at risk of or are perceived to have violated these norms face immense pressure for early marriage to mitigate damage to both their own and their families' reputations. DISCUSSION: Social norms that are primarily engineered to control girls' sexuality continue to underpin the practice of child marriage in Bangladesh. Efforts to reduce child marriage such as through increased education or economic opportunities must also address these norms if substantial reductions are to be achieved and sustained in the long-term.

Men's Use of Economic Coercion Against Women in Rural Bangladesh.

Objective: Bangladesh is historically a patriarchal society, but has made recent strides in increasing educational and economic opportunities for women. Yet men continue to perpetrate economic coercion and other forms of intimate partner violence against women in Bangladesh. This study examines how men in rural Bangladesh shape the economic activities of their wives within the context of changing norms around women's involvement in economic domains. Men's perspectives are not often explored in the literature and can provide valuable insight into how and why economic coercion persists. Method: 25 in-depth interviews were conducted with men in rural Bangladesh and analyzed using thematic analysis. Results: Men engaged in economically coercive practices, both implicitly and explicitly. Three themes captured how men perpetrated economic coercion: they held gendered expectations about how and if women should participate in economic activities, they monitored women's activities to ensure they conformed to the men's gendered expectations, and they placed explicit restrictions on women's economic activities to align with and maintain gender inequitable norms. Conclusion: These findings call attention to how men continue to see themselves as dominant over women in rural Bangladesh, despite the progress made in expanding educational and economic opportunities for women. The analysis points to the need for interventions that go beyond increased access to educational and economic programs for women to address the persistence of gender inequitable norms within patriarchal societies.

Telomere length is associated with growth in children in rural Bangladesh.

Background: Previously, we demonstrated that a water, sanitation, handwashing, and nutritional intervention improved linear growth and was unexpectedly associated with shortened childhood telomere length (TL) (Lin et al., 2017). Here, we assessed the association between TL and growth. Methods: We measured relative TL in whole blood from 713 children. We reported differences between the 10th percentile and 90th percentile of TL or change in TL distribution using generalized additive models, adjusted for potential confounders. Results: In cross-sectional analyses, long TL was associated with a higher length-for-age Z score at age 1 year (0.23 SD adjusted difference in length-for-age Z score [95% CI 0.05, 0.42; FDR-corrected p-value = 0.01]). TL was not associated with other outcomes. Conclusions: Consistent with the metabolic telomere attrition hypothesis, our previous trial findings support an adaptive role for telomere attrition, whereby active TL regulation is employed as a strategy to address 'emergency states' with increased energy requirements such as rapid growth during the first year of life. Although short periods of active telomere attrition may be essential to promote growth, this study suggests that a longer overall initial TL setting in the first 2 years of life could signal increased resilience against future telomere erosion events and healthy growth trajectories. Funding: Funded by the Bill and Melinda Gates Foundation. Clinical trial number: NCT01590095.

Maternal experience of domestic violence before and during pregnancy and children's linear growth at 15 years: Findings from MINIMat trial in rural Bangladesh.

Literature concerning negative impacts of domestic violence (DV) against women on their children's health is growing; however, little is known about the long-term effect of maternal exposure to DV before and/or during pregnancy on their children's growth. Using data from the MINIMat cohort, we have evaluated the association between maternal lifetime experience of DV, measured in late pregnancy, with their children's linear growth at 15 years (n = 2240) in rural Bangladesh. A modified version of conflict tactic scale was used to record the maternal experience of physical, sexual, emotional DV and controlling behaviour. Children's height was measured by trained nurses during their clinical visits at 15-year follow-up. Compared to the women with no experience of DV, children of women with experience of any physical, sexual or emotional DV before and/or during pregnancy had the significantly lower height for age Z-scores (HAZs) at the age of 15. No significant association between maternal experience of controlling behaviour and their children's linear growth was observed in terms of HAZ. Results from this study suggest that maternal experience of DV before and/or during pregnancy might be associated with impaired long-term linear growth within their children.

Learnings from the evaluation of HERrespect: a factory-based intervention to prevent intimate partner and workplace violence against female garment workers in Bangladesh.

Background: Intimate partner violence (IPV) and workplace violence (WPV) against women are widespread globally, and we set out to establish whether an intervention on gender-transformative programming delivered to Bangladeshi garment factory workers could reduce women's experience of IPV and WPV. We developed and tested an intervention, HERrespect and encountered considerable obstacles. Objective: To describe the challenges in program implementation and evaluation in the factories and the serious implications that arose for the study outcomes. Methods: HERrespect is a participatory intervention with mostly parallel group sessions for female and male workers and the management staff, designed to be delivered weekly in three hourly sessions, and supported by some factory-wide and limited community information campaigns. It was evaluated in a quasi-experimental study conducted in eight garment factories in and around Dhaka city, with a cohort of 800 women workers and 395 management staff who were followed for 24 months. Results: The study was conducted in the ready-made garment industry with substantial power imbalances between buyers, factory management and workers. The factories were contacted through the buyers, and some factories had agreed to participate half-heartedly. Many did not make enough time available for optimal implementation. Thus, the sessions were shortened and spread out. The factories did not make all the group members available for sessions. Whilst agreeing to participate, some management undermined the research by warning workers against disclosing information that may harm the business, resulting in the endline data being unreliable. Conclusions: Future research on IPV prevention in this sector is advised to: (1) Gain genuine management buy-in prior to starting activities; (2) implement an optimally intensive programme for the workers and management; (3) engage men from the female workers' communities. WPV prevention will require a change in the structural violence of the just-in-time regime which contributes largely to WPV.

Multilevel Control Over Sexuality of Unmarried Adolescent Girls and Related Violence: A Qualitative Exploration in Slums of Dhaka, Bangladesh.

High concerns about sexuality of unmarried adolescent girls (UAGs) in patriarchal societies and perceived links between sexuality and honor are likely to trigger controlling behavior and underlie a range of violence perpetrated against them. These concerns are heightened in the urban slums of Bangladesh, where economic and social changes challenge traditional gender roles and behaviors. Little is, however, known about control of and violence against UAGs perpetrated by families, romantic partners, and community. Using 12 key informant interviews, 15 focus group discussions, and 27 in-depth interviews carried out between June and November 2011 in Dhaka slums, this study explores the sociocultural expectations around sexuality of UAGs, how they interact with ground reality, control, resultant conflicts, violence against UAGs, and the ways UAGs grapple with controlling behavior and violence. The findings show that perceptions, attitudes, and expectations about the behavior of these girls remain patriarchal despite changes in economic and social circumstances reshaping gender roles and practices. Patriarchy finds new ways of controlling the girls by imposing dress codes, setting new boundaries for mobility and interaction with the opposite sex, and inflicting different forms of violence at different levels of the society. Some girls attempt to avoid violence by conforming to the new rules, while many negotiate the new boundaries with the family, romantic partner, and community. UAGs sometimes make compromises in one domain or level, while they resist control and violence in another. The findings lend support to the patriarchal bargain theory. Promotion of nonpatriarchal norms is expected to reduce vulnerability of these girls to violence.

Intimate partner violence is associated with poorer maternal mental health and breastfeeding practices in Bangladesh.

Exposure to intimate partner violence (IPV) can have profound adverse consequences on maternal and child health. This study aimed to: (1) identify factors associated with IPV during pregnancy and postpartum in Bangladesh; and (2) assess the associations between IPV and maternal mental health and breastfeeding practices. We used data from a cross-sectional survey of 2000 mothers with children <6 months in four districts in Bangladesh. We applied multivariable logistic regression models to examine factors associated with IPV and structural equation modelling to assess the inter-relationships between IPV, maternal common mental disorders (CMD, measured by Self-reporting Questionnaire ≥7) and breastfeeding practices. Overall, 49.7% of mothers experienced violence during the last 12 months and 28% of mothers had high levels of CMD. Only 54% of women reported early initiation of breastfeeding and 64% reported exclusive breastfeeding. Women were more likely to experience IPV if living in food-insecure households, being of low socio-economic status, having low autonomy or experiencing inequality in education compared with husbands (OR ranged from 1.6 to 2.8). Women exposed to IPV were 2-2.3 times more likely to suffer from high levels of CMD and 28-34% less likely to breastfeed their babies exclusively. The indirect path (the indirect effects of IPV on breastfeeding through CMD) through maternal CMD accounted for 14% of the relationship between IPV on breastfeeding practice. In conclusion, IPV is pervasive in Bangladesh and is linked to increased risks of CMD and poor breastfeeding practices. Integrating effective interventions to mitigate IPV, along with routine maternal and child health services and involving men in counselling services, could help both to reduce exposure to IPV among women and to contribute to better health outcomes for women and children.

Maternal Experience of Domestic Violence, Associations with Children's Lipid Biomarkers at 10 Years: Findings from MINIMat Study in Rural Bangladesh.

The consequences of maternal experience of Domestic Violence (DV) on their children's cardio-metabolic risk factors are unclear. We aimed to assess if maternal exposure to any or a specific form of DV (i.e., physical, sexual, emotional and controlling behaviors) before and after childbirth was associated with their children's lipid biomarkers at the age of 10 years. A current observational sub-study of a larger MINIMat trial included a cohort of 1167 mothers and their children. The conflict tactic scale was used to record women's experience of lifetime DV before and after childbirth at week 30 of pregnancy and at a 10-year follow up, respectively. Five ml of fasting blood sample was collected from the children to evaluate their lipid profile. Children of women who experienced any DV before childbirth had lower Apo A (ßadj -0.04; 95% CI: -0.08, -0.01). Women who experienced physical DV both before and after childbirth had children with higher triglycerides (ßadj 0.07; 95% CI: 0.01, 0.14). Children whose mother experienced sexual DV before birth had lower Apo A (ßadj -0.05; 95% CI: -0.08, -0.01) and High Density Lipoprotein (HDL) (ßadj -0.05; 95% CI: -0.10, -0.01) as well as higher Low Density Lipoprotein (LDL) (ßadj 0.17; 95% CI: 0.05, 0.29) and LDL/HDL (ß 0.24; 95% CI: 0.11, 0.38). However, levels of LDL (ßadj -0.17; 95% CI: -0.28, -0.06), LDL/HDL (ßadj -0.12; 95% CI: -0.25, -0.00) and cholesterol (ßadj -0.13; 95% CI: -0.25, -0.02) were lower among the children of mothers who experienced controlling behavior after childbirth. Results from the current study suggest that maternal experience of physical or sexual DV might negatively affect their children's lipid profile at the age of 10 years.

Multilevel Influences on Depressive Symptoms among Men in Bangladesh.

Depression is a worldwide problem, and is especially prevalent in lower-income countries with insufficient resources and widespread poverty, such as Bangladesh. Yet multilevel determinants of depressive symptoms in men have not been studied in this context. We leverage a novel dataset from men in Bangladesh to determine the community- and individual-level influences of masculine dominance strain and financial strain on the frequency of married men's depressive symptoms in Bangladesh. Data were collected between January and June, 2011, as part of the UN Multi-Country Study of Men and Violence, conducted by The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Masculine dominance strain at both levels was related to the frequency of depressive symptoms. Financial strain only at the individual level was related to the frequency of depressive symptoms. We conclude that community-level economic interventions may not directly influence individual-level depression; however, addressing customary conceptions of masculinity at the community and individual level and addressing individual-level financial strain are promising joint strategies to improve married men's mental health in Bangladesh and similar settings.

Magnitude and correlates of intimate partner violence against female garment workers from selected factories in Bangladesh.

Intimate partner violence (IPV) is a huge public health, development and human rights issue worldwide. Despite the fact that working women in patriarchal contexts commonly report higher level of IPV, literature on this subject is still scanty. This paper assessed the magnitude of different types of IPV against female garment workers and identified its correlates using cross-sectional survey data collected during September-December, 2016 from 800 female garment workers randomly selected from lists provided by eight garment factories in and around Dhaka, Bangladesh. The results reveal high levels of IPV experienced by the workers (physical = 34%; sexual = 43%; economic = 35%, last 12 months). Logistic regression results were nuanced. While the worker's ability to mobilize resources in crises reduced IPV, her savings beyond a threshold increased its likelihood. Moreover, her ownership of jewellery/ large household assets increased the likelihood of IPV. Having moderately or highly controlling husband, substance abuse by husband and his involvement in extramarital sex predicted IPV. Although the worker's education up to 6 years or more was protective, education more than the husband increased the likelihood of IPV. Young age, having two or more children, experience of non-partner sexual violence and high acceptance of IPV increased the likelihood of IPV. Middle income group protected against IPV, while household food insecurity increased its likelihood. Work at a factory in the Export Processing Zone protected against IPV. The findings indicate that financial empowerment alone is not sufficient to protect the workers from IPV; interventions that combine gender empowerment training for workers in the context of better factory working conditions may be useful in reducing IPV; working with men is essential in this endeavour.

The pathways between female garment workers' experience of violence and development of depressive symptoms.

BACKGROUND: The prevalence of intimate partner violence (IPV) is high (54%) in Bangladesh. Moreover, female garment workers report higher rates of IPV and are also vulnerable to workplace violence (WPV). Experience of violence puts women at increased risk of developing depressive symptoms, which are related with low self-esteem, lower life satisfaction and lower productivity. To our knowledge, there has been no previous research on depression among female garment workers and its connections to IPV and WPV in Bangladesh. This paper aims to address this gap by studying the relationship of IPV, WPV and depression among female garment workers. METHODS: The data for this paper comes from a cross-sectional survey of female garment workers (n = 800) conducted as baseline survey of a quasi-experimental study known as HERrespect. Survey data were collected during September-December, 2016 among randomly selected female garment workers from eight garment factories in and around Dhaka city. Structural equation modelling was conducted to explore the relationship among IPV, WPV and depression. RESULTS: The findings show high rates of any IPV (69%); WPV (73%, experienced or witnessed) and depressive symptomatology (40%) among female garment workers. The analysis of pathways shows that IPV impacts a woman's experience of WPV and work related stress leading to the development of depression; while WPV had direct and mediated pathways to depression. Experience of controlling by their husband leads to WPV and increased work related stress, and thus leads to depression. It also reveals that a worker's ability to mobilize resources in emergency, however, increased self-esteem and reduced work related stress. CONCLUSION: This study shows the pathways through which experience of IPV and WPV lead to development of depressive symptoms among female garment workers. The link between women's ability to mobilize resources with self-esteem and work related stress indicates the need for socio-economic empowerment of women and may suggest that combined intervention to address IPV and women's empowerment could be successful in dealing with WPV and mental health.